1962667782 NPI number — BOW CREEK RECOVERY CENTER

Table of content: DR. DUNCAN STEWART BARLOW M.D. (NPI 1891780003)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962667782 NPI number — BOW CREEK RECOVERY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOW CREEK RECOVERY CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962667782
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24093 BOW CREEK LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CALDWELL
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-459-1883
Provider Business Mailing Address Fax Number:
208-455-1392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24093 BOW CREEK LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CALDWELL
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83607-7529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-459-1883
Provider Business Practice Location Address Fax Number:
208-455-1392
Provider Enumeration Date:
07/21/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DENGLER
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
SUSAN
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
510-520-2466

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)